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CDA 10-202
Assessing and Responding to Intimate Partner Violence among Women Veterans
Melissa E. Dichter PhD MSW
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
Philadelphia, PA
Funding Period: August 2011 - July 2016

BACKGROUND/RATIONALE:
Intimate partner violence (IPV) is a widespread social problem, impacting more than one in three women in the United States and as many as 50% of women seeking primary healthcare. IPV exposure is a risk factor for a variety of medical and mental health problems; healthcare providers can be helpful in detecting and responding to IPV to prevent further violence exposure and to help patients heal from the physical, psychological, and social wounds caused by IPV. Women are the fastest growing segment of the veteran population seeking health care from the VA and at high risk of morbidity and mortality resulting from IPV victimization. This program of research seeks to fill gaps in knowledge about IPV among women veterans and inform interventions to address the unmet needs within the Veterans Health Administration (VHA).

OBJECTIVE(S):
The specific research objectives are to: 1) identify the prevalence and impacts of IPV on health and healthcare experiences of women veterans, including the unique relationships between IPV and military experiences; 2) identify the patient, provider, and system-level factors that facilitate or inhibit VHA assessment of, and response to, IPV among women veterans; and 3) implement and test a VHA-based IPV screening and response model.

METHODS:
Study 1 aims to assess the scope of IPV experiences, IPV-related health and healthcare needs, and perspectives on VHA-based IPV assessment and intervention, from the point-of-view of VHA patients, clinicians, and administrators. This study involves three phases of data collection: I) a face-to-face survey of women veteran patients, II) in-depth interviews with women veteran patients, and III) interviews with VA clinicians. Study 2 will test a detection and response program within the VA system to assess detection of IPV using a patient self-administered screening process, feasibility, and patient and staff acceptability.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Findings on the scope of IPV experiences, associated health conditions, and perspectives on VHA response to IPV among women VHA patients, as well as VHA clinicians' experiences and perspectives, serve to inform the development and implementation of IPV screening and response in VHA. Examination of IPV screening and referral, and patients' experiences of health and social conditions, as well as empowerment and safety, over time, will provide further knowledge about the ways in which healthcare systems can better meet the needs of patients who have experienced IPV and are at risk of IPV-related health and social impacts. From these studies, we can better understand the experiences and needs of women veterans and non-veteran VHA patients regarding IPV and associated healthcare needs.

PUBLICATIONS:

Journal Articles

  1. Dichter ME, Wagner C, Borrero S, Broyles L, Montgomery AE. Intimate partner violence, unhealthy alcohol use, and housing instability among women veterans in the Veterans Health Administration. Psychological Services. 2017 May 1; 14(2):246-249.
  2. Dichter ME, Haywood TN, Butler AE, Bellamy SL, Iverson KM. Intimate Partner Violence Screening in the Veterans Health Administration: Demographic and Military Service Characteristics. American journal of preventive medicine. 2017 Jun 1; 52(6):761-768.
  3. Dichter ME, Wagner C, True G. Women Veterans' Experiences of Intimate Partner Violence and Non-Partner Sexual Assault in the Context of Military Service: Implications for Supporting Women's Health and Well-Being. Journal of interpersonal violence. 2018 Mar 1; 33(6):843-864.
  4. Kimerling R, Iverson KM, Dichter ME, Rodriguez AL, Wong A, Pavao J. Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care. Journal of general internal medicine. 2016 Aug 1; 31(8):888-94.
  5. Iverson KM, Stirman SW, Street AE, Gerber MR, Carpenter SL, Dichter ME, Bair-Merritt M, Vogt D. Female veterans' preferences for counseling related to intimate partner violence: Informing patient-centered interventions. General hospital psychiatry. 2016 May 1; 40:33-8.
  6. Montgomery AE, Dichter ME, Thomasson AM, Roberts CB. Services Receipt Following Veteran Outpatients' Positive Screen for Homelessness. American journal of preventive medicine. 2016 Mar 1; 50(3):336-43.
  7. Wagner C, Dichter ME, Mavandadi S, Klaus J, Oslin DW. Gender Differences in Social Relationships and Mental Health among Veterans Affairs Patients. Military Behavioral Health. 2016 Feb 26; 4(3):220-229.
  8. Dichter ME, Wagner C, True G. Timing of Intimate Partner Violence in Relationship to Military Service Among Women Veterans. Military medicine. 2015 Nov 1; 180(11):1124-7.
  9. Iverson KM, Vogt D, Dichter ME, Carpenter SL, Kimerling R, Street AE, Gerber MR. Intimate Partner Violence and Current Mental Health Needs Among Female Veterans. Journal of the American Board of Family Medicine : JABFM. 2015 Nov 1; 28(6):772-6.
  10. Wagner C, Dichter ME, Mattocks K. Women Veterans' Pathways to and Perspectives on Veterans Affairs Health Care. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2015 Nov 1; 25(6):658-65.
  11. Dichter ME, Wagner C, Goldberg EB, Iverson KM. Intimate Partner Violence Detection and Care in the Veterans Health Administration: Patient and Provider Perspectives. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2015 Sep 1; 25(5):555-60.
  12. McCauley HL, Blosnich JR, Dichter ME. Adverse Childhood Experiences and Adult Health Outcomes Among Veteran and Non-Veteran Women. Journal of women's health (2002). 2015 Sep 1; 24(9):723-9.
  13. Dichter ME, True JG. "This is the story of why my military career ended before it should have:” Premature separation from military service among U.S. women Veterans. Affilia. 2015 May 1; 30(2):187-199.
  14. Montgomery AE, Dichter ME, Thomasson AM, Roberts CB, Byrne T. Disparities in housing status among veterans with general medical, cognitive, and behavioral health conditions. Psychiatric services (Washington, D.C.). 2015 Mar 1; 66(3):317-20.
  15. Cerulli C, Kothari C, Dichter M, Marcus S, Kim TK, Wiley J, Rhodes KV. Help-seeking patterns among women experiencing intimate partner violence: do they forgo the criminal justice system if their adjudication wishes are not met? Violence and victims. 2015 Jan 1; 30(1):16-31.
  16. Cerulli C, Trabold N, Kothari CL, Dichter ME, Raimondi C, Lucas J, Cobus A, Rhodes KV. In our voice: survivors’ recommendations for change. Journal of family violence. 2015 Jan 1; 30(1):75-83.
  17. Montgomery AE, Dichter ME, Thomasson AM, Fu X, Roberts CB. Demographic characteristics associated with homelessness and risk among female and male veterans accessing VHA outpatient care. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2015 Jan 1; 25(1):42-8.
  18. Dichter ME, Marcus SC, Wagner C, Bonomi A. Associations between psychological, physical, and sexual intimate partner violence and health outcomes among women Veteran VA patients. Social work in mental health. 2014 Oct 1; 12(5-6):411-428.
  19. Blosnich JR, Dichter ME, Cerulli C, Batten SV, Bossarte RM. Disparities in adverse childhood experiences among individuals with a history of military service. JAMA psychiatry (Chicago, Ill.). 2014 Sep 1; 71(9):1041-8.
  20. Cerulli C, Kothari CL, Dichter M, Marcus S, Wiley J, Rhodes KV. Victim Participation in Intimate Partner Violence Prosecution: Implications for Safety. Violence Against Women. 2014 Jun 2; 20(5):539-560.
  21. Gerber MR, Iverson KM, Dichter ME, Klap R, Latta RE. Women veterans and intimate partner violence: current state of knowledge and future directions. Journal of women's health (2002). 2014 Apr 1; 23(4):302-9.
  22. Cerulli C, Bossarte RM, Dichter ME. Exploring intimate partner violence status among male veterans and associated health outcomes. American Journal of Men's Health. 2014 Jan 1; 8(1):66-73.
  23. Dichter ME, Marcus S. Intimate partner violence victimization among women Veterans: health, healthcare service use, and opportunities for intervention. Military Behavioral Health. 2013 Aug 5; 1(2):107-113.
  24. Dichter ME, True JG, Marcus SC, Gerlock AA, Yano EM. Documentation of intimate partner violence in women Veterans' medical records: an in-depth analysis. Military Behavioral Health. 2013 Aug 5; 1(2):114-120.
  25. Mattocks KM, Sadler A, Yano EM, Krebs EE, Zephyrin L, Brandt C, Kimerling R, Sandfort T, Dichter ME, Weiss JJ, Allison J, Haskell S. Sexual victimization, health status, and VA healthcare utilization among lesbian and bisexual OEF/OIF veterans. Journal of general internal medicine. 2013 Jul 1; 28 Suppl 2:S604-8.
  26. Dichter ME. "They arrested me—and I was the victim": women’s experiences with getting arrested in the context of domestic violence. Women & criminal justice. 2013 Mar 11; 23(2):81-98.
  27. Byrne T, Montgomery AE, Dichter ME. Homelessness among female veterans: a systematic review of the literature. Women & health. 2013 Jan 1; 53(6):572-96.
  28. Kothari CL, Rhodes KV, Wiley JA, Fink J, Overholt S, Dichter ME, Marcus SC, Cerulli C. Protection orders protect against assault and injury: a longitudinal study of police-involved women victims of intimate partner violence. Journal of interpersonal violence. 2012 Sep 1; 27(14):2845-68.
  29. Dichter ME, Gelles RJ. Women's perceptions of safety and risk following police intervention for intimate partner violence. Violence Against Women. 2012 Jan 1; 18(1):44-63.
  30. Edwardsen EA, Dichter ME, Walsh P, Cerulli C. Instructional curriculum improves medical staff knowledge and efficacy for patients experiencing intimate partner violence. Military medicine. 2011 Nov 1; 176(11):1260-4.
  31. Rhodes KV, Kothari CL, Dichter M, Cerulli C, Wiley J, Marcus S. Intimate partner violence identification and response: time for a change in strategy. Journal of general internal medicine. 2011 Aug 1; 26(8):894-9.
  32. Dichter ME, Cerulli C, Bossarte RM. Intimate partner violence victimization among women veterans and associated heart health risks. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2011 Jul 1; 21(4 Suppl):S190-4.
  33. Dichter ME, Marcus SC, Morabito MS, Rhodes KV. Explaining the IPV arrest decision: incident, agency and community factors. Criminal justice review. 2011 Mar 1; 36(1):22-39.
Book Chapters

  1. Tinney GT, Dichter ME. Intimate partner violence, military personnel, and Veterans. In: Ritchie EC, Naclerio AL, editors. Women at War. New York, NY: Oxford University Press; 2015. Chapter 15. 266-300 p.
Center Product

  1. Dichter ME. Women’s experiences of abuse as a risk factor for incarceration: a research update [National Online Resource Center on Violence Against Women]. 2015 Jul 1.
  2. Dichter ME, Iverson KM. Research to enhance patient-centered care for intimate partner violence in the Veterans Health Administration [Futures without Violence Health E-Bulletin]. 2015 Jul 1; (Summer 2015).
CYBR

  1. Dichter ME, Iverson KM. Intimate partner violence among women Veterans: informing patient-centered care in VHA [Spotlight on Women's Health]. [Cyberseminar]. 2015 Sep 8.
  2. Dichter ME, Gabrielian S. Special populations: homeless Veterans and Veterans experiencing intimate partner violence. [Cyberseminar]. 2013 Nov 20.
Conference Presentations

  1. Dichter ME, Wagner C. Emotional support as protective of negative health outcomes among women with sexual assault experience. Poster session presented at: AcademyHealth Gender and Health Interest Group Annual Meeting; 2016 Jun 13; Boston, MA.
  2. Dichter ME, Wagner C, Montgomery AE. Intersection of Interpersonal Violence and Military Service: Women Military Veterans' Experiences. Paper presented at: AcademyHealth Gender and Health Interest Group Annual Meeting; 2016 Jun 13; Boston, MA.
  3. Dichter ME, Wagner C, True JG. Intersection of Interpersonal Violence and Military Service: Women Military Veterans' Experiences. Paper presented at: Society for Social Work and Research Annual Conference; 2016 Jan 13; Washington, DC.
  4. Wagner C, Dichter ME. Associations between childhood abuse, adult sexual trauma, and mental health outcomes among women Veterans. Paper presented at: Association for Psychological Science Annual Convention; 2015 May 21; New York, NY.
  5. Dichter M, Wagner C, Borrero S, Montgomery A, Broyles LM. Association between intimate partner violence and homelessness risk, unhealthy alcohol use, and risk of unintended pregnancy. Paper presented at: Futures Without Violence Biennial National Conference on Health and Domestic Violence; 2015 Mar 20; Washington, DC.
  6. Dichter ME, Czarnogorski M, Maas L, Broonfield J. Diffusion of innovation: Department of Veterans Affairs pilot project to disseminate IPV programs in women’s health clinics through mentoring. Paper presented at: Futures Without Violence Health and Domestic Violence National Biennial Conference; 2015 Mar 20; Washington, DC.
  7. Dichter ME, Iverson KM, Kimerling RK, Sadler AG. Patient-centered care for interpersonal violence in the Veterans Health Administration: screening, counseling, and engagement with care. Paper presented at: Futures Without Violence National Conference on Health and Domestic Violence; 2015 Mar 20; Washington, DC.
  8. Dichter ME, Marcus SC, Wagner C, Bonomi A. Unique contributions of sexual violence victimization to poor health outcomes among women. Paper presented at: Futures Without Violence Health and Domestic Violence National Biennial Conference; 2015 Mar 20; Washington, DC.
  9. Dichter ME, True JG, Marcus SC, Gerlock AA, Yano EM. Detection and documentation of intimate partner violence victimization among women patients. Paper presented at: Futures Without Violence Health and Domestic Violence National Biennial Conference; 2015 Mar 20; Washington, DC.
  10. Dichter ME. Veteran and provider preferences for IPV screening and counseling procedures within VA. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 8; San Diego, CA.
  11. Dichter ME. Talking with healthcare providers about intimate partner violence: Perspectives of women primary care patients. Paper presented at: American Public Health Association Annual Meeting and Exposition; 2013 Nov 2; Boston, MA.
  12. Dichter ME. Unique contributions of sexual violence victimization to poor health outcomes among women. Paper presented at: American Public Health Association Annual Meeting and Exposition; 2013 Nov 2; Boston, MA.
  13. Dichter ME. Intersection between family violence exposure and military service: impacts on health, well-being, health care, and help-seeking. Paper presented at: American Public Health Association Annual Meeting and Exposition; 2013 Nov 2; Boston, MA.
  14. Dichter ME, True JG, Marcus SC. Detection and documentation of intimate partner violence victimization among women patients. Paper presented at: AcademyHealth Gender and Health Interest Group Annual Meeting; 2013 Jun 22; Baltimore, MD.
  15. Cerulli C, Kothari CL, Dichter ME, Rhodes KV. Separate silos: closing the gaps between the medical and legal systems’ response to IPV. Paper presented at: Futures Without Violence Health and Domestic Violence National Biennial Conference; 2012 Jul 30; San Francisco, CA.
  16. Dichter ME, Marcus SC. Intimate partner violence and women veterans: the need for a standardized response. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 18; National Harbor, MD.


DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Epidemiology, Treatment - Observational, Prevention, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: Clinical Diagnosis and Screening
MeSH Terms: none